Healthcare Provider Details

I. General information

NPI: 1912041757
Provider Name (Legal Business Name): RUSSELL COUNTY HEALTH DEPT VFC IMMUN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CRAWFORD RD
PHENIX CITY AL
36867-4222
US

IV. Provider business mailing address

PO BOX 548
PHENIX CITY AL
36868-0548
US

V. Phone/Fax

Practice location:
  • Phone: 334-297-0251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: REGINA L PATTERSON
Title or Position: DIRECTOR OF HEALTH SYSTEMS
Credential:
Phone: 334-206-5061